UPDATED: House kills bill to block Medicaid expansion

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CONCORD -- The House wants the state to expand the Medicaid program under the Affordable Care Act to help reduce the number of people not covered by health insurance.The House voted 206-155 Wednesday to kill House Bill 271 which would prohibit the state from expanding the federal-state health insurance program for the poor, elderly and disabled.The bill is sponsored by Former House Speaker William O’Brien, R-Mont Vernon, who argued the program is unaffordable, not needed and claims it would “hijack the state’s budget.”“We can do better for our poor and near poor than putting them on this system,” O’Brien said. “It is a failed system.”He also argued there is no free lunch and said the federal government cannot live up to its promises with the growing federal debt.“We’re not Cyprus and the federal government is not Germany,” O’Brien said. “(The money) has to come from us, from our taxes or come from further borrowing from our grandchildren and their grandchildren.”But bill opponents say the expansion will significantly increase the number of people with health insurance and will bring billions of dollars of federal money to the state’s health care providers.“It doesn’t matter whether you are for or against Medicaid expansion, under this bill discussion will be cut off today if you pass it,” said Rep. Thomas Sherman, D-Rye. “Let’s defeat this bill for the sake of many New Hampshire citizens, our friends, our neighbors, our families and my patients.”The expansion is projected to add between 35,000 to 50,000 people to the program in seven years, according to an independent organization the state hired to study the state’s options. The Lewin Group also said along with other provisions of the ACA, the expansion would reduce the state’s uninsured from about 170,000 to 71,000.Expanding the program would cost the state about $85 million over seven years, but would inject $2.5 billion into the state’s economy, according to the study.During Wednesday’s hour-long debate, bill supporters say the cost to the state will be much higher than the Lewin Group estimated.Rep. Richard Meaney, R-Goffstown, said the cost of expansion will be at least $15 million a year through 2019, then from $50 million to $100 million a year in the state budget for this federal program.“New Hampshire citizens are not ready for $50 million to $100 million in new taxes,” Meaney said, and added the state along with 39 other states will be net payers for the national program.“If we expand Medicaid in New Hampshire we will leave a legacy of debt for our children and our grandchildren,” he said.Bill opponents said expansion will not cost the state anything under a managed care program the state has yet to implement.The federal government has a very good track record in meeting its Medicaid obligation, said Rep. Laurie Harding, D-Lebanon, noting some of the provider-payment problems rest with the state, not the federal government. The state can decide to drop the program at any time, she added.The Lewin Group study says expansion would have no net costs to state general funds during the first two years and would bring $422 million in federal funds to the New Hampshire economy, Harding said.Harding said cashiers, daycare workers and other low-income workers will have an opportunity to have health insurance. “These people have never had health insurance before and now it is their time,” she said.Other bill supporters argued the program will drive up the cost of private insurance for businesses and individuals and will increase the use of emergency room care.O’Brien said the state should turn to private sector solutions such as removing mandates on insurers, allowing cross border sales and encouraging individual health care savings accounts, instead of growing government dependency.But Sherman said the program will help improve the health of the poor, citing a Harvard study that found nationally the uninsured have a 40 percent higher risk of death based solely on their insurance status and are less likely to receive care and seek treatment.He said many people struggle to pay for their food and rent. Those patients end up in emergency rooms and can barely afford follow up visits to their doctors, said Sherman, a physician.“Too often we see them back in the emergency room,” he said. “We have the tools to maintain their health, they just can’t afford them.”Gov. Maggie Hassan backs expanding the program and recently asked to partner with the federal government in setting health insurance exchanges to allow individuals and small businesses to find the best health insurance policies.The federal health and human services agency accepted the state’s request and is working with officials to set up the program.The House will also vote on another bill later this month requiring the state to expand the Medicaid program under the ACA.grayno@unionleader.com